In early 2025, a British cancer charity shipped a PET-CT scanner to a private hospital in Nairobi's leafy suburbs. The machine, worth roughly $2 million, can detect tumours smaller than a grain of rice. But 15 kilometres away, at Kenyatta National Hospital, two linear accelerators—workhorses of radiotherapy—had been sitting idle for weeks because replacement parts had not arrived and no technician was available to recalibrate them. The contrast captures a paradox that oncologists in Kenya have come to know well: foreign donations often land where they look best, not where they are needed most.

A Scanner Gift, a Machine Silent

The PET-CT scanner, donated by a UK-based cancer fund that prefers to remain unnamed in local press, was installed at the Aga Khan University Hospital in Nairobi. It is the first such machine in East Africa with time-of-flight technology, which improves image quality. The hospital celebrated the arrival with a press conference and a tour for donors. Oncologists from the public sector were not invited.

Meanwhile, at Kenyatta National Hospital, the country's largest public referral centre, two of the four linear accelerators were non-functional. One had a failed magnetron; the other needed software recalibration. The hospital's biomedical engineering team had submitted purchase orders months earlier, but the procurement process stalled. Patients with cervical cancer—the most common cancer among Kenyan women—were placed on waitlists that stretched three to four months.

Dr. Anne Njeri, a radiation oncologist at Kenyatta, told local media that the situation was demoralising. "We have skilled staff who can treat patients, but the machines let us down. Meanwhile, a scanner that costs more than our entire annual radiotherapy budget arrives at a private hospital where only the wealthy can use it." The gap is not just about money; it is about how donor priorities shape—and sometimes distort—a country's cancer control strategy.

The Kenyan Ministry of Health has limited authority to reject donations, even when they duplicate existing capacity or impose hidden costs. A 2023 audit by the African Centre for Disease Control found that roughly 40% of donated medical equipment in sub-Saharan Africa is never put into clinical use. The PET scanner in Nairobi is likely to operate at high volume, but its impact on population-level cancer outcomes will be marginal, since most Kenyans present with advanced disease that is incurable regardless of imaging.

The charity behind the donation, which asked not to be named to avoid scrutiny of its project selection, has a history of funding high-profile imaging centres in low- and middle-income countries. Its website highlights "transformative technology" as a key focus area. But critics argue that such donations, while well-intentioned, can inadvertently reinforce inequities by channeling resources toward equipment that serves a small, affluent minority rather than strengthening foundational services like radiotherapy.

PET Scans for the Few, Not the Many

PET-CT imaging is used primarily to stage cancers and detect recurrence. It is invaluable for certain malignancies—lung cancer, lymphoma, colorectal cancer—but it is expensive. A single scan at Aga Khan costs around $800, roughly the monthly salary of a primary school teacher in Nairobi. There is no public-sector PET referral pathway; patients referred from Kenyatta National Hospital must pay out of pocket or rely on charitable subsidies.

The donation agreement did not include a plan for subsidised access for public patients. The charity covered the purchase price but not the recurring costs: the cyclotron-produced radioisotopes, the maintenance contract, the trained radiographers. Those costs fall on the hospital, which in turn passes them to patients. A 2024 study in The Lancet Oncology estimated that less than 5% of cancer patients in Kenya have access to PET imaging, and nearly all of them are privately insured or self-paying.

Dr. James Mwangi, a health policy researcher at the University of Nairobi, argues that the donation reinforces a two-tier system. "Donors love high-tech machines because they produce good photos for annual reports. But they rarely ask whether the machine will reduce mortality. For cervical cancer, a $500 cryotherapy device can prevent progression from precancer to invasive disease. That saves more lives than a PET scanner ever will." His point is not that PET scanners are useless, but that they are a poor fit for a system that lacks basic radiotherapy capacity.

The Ministry of Health's National Cancer Control Strategy 2023–2027 prioritises prevention, early detection, and strengthening radiotherapy. Nowhere does it call for additional PET capacity. Yet donor-driven projects continue to arrive, often negotiated directly with hospital administrators rather than through the ministry. This fragments the health system and makes coordinated planning nearly impossible.

Radiotherapy Crisis by the Numbers

Kenya has roughly 10 functional linear accelerators (linacs) for a population of about 55 million people. That works out to one machine per 5.5 million people. The World Health Organization recommends at least one per 1 million. Even by that modest standard, Kenya is short by about 45 machines. The shortage is compounded by frequent breakdowns: a 2022 survey by the International Atomic Energy Agency found that Kenyan linacs operate at an average uptime of 60%, meaning they are non-functional roughly 40% of the time.

The reasons are predictable. Spare parts must be imported, often from Europe or the United States, and customs clearance can take weeks. Calibration requires specialised engineers, of whom Kenya has fewer than a dozen. Service contracts are expensive; some hospitals let them lapse to save money. When a machine breaks, patients are referred to other facilities or simply told to wait. A 2023 audit by the Kenya Medical Practitioners and Dentists Council found that wait times for radiotherapy at Kenyatta National Hospital averaged 14 weeks, well above the clinically recommended maximum of four weeks.

For cervical cancer, the consequences are stark. Radiotherapy is essential for locally advanced disease, which accounts for roughly 70% of cases at diagnosis. Without timely treatment, tumours progress, causing pain, bleeding, and death. A 2024 modelling study in JCO Global Oncology estimated that improving radiotherapy access in Kenya to the WHO-recommended level could avert roughly 8,000 premature deaths per year from cervical cancer alone. That is roughly the same number of women who die from the disease annually in the country.

The Kenyan government has committed to expanding radiotherapy capacity. The 2023/24 budget allocated $12 million for new linacs and bunker construction. But procurement is slow, and the machines that arrive must compete with other priorities. Meanwhile, donated machines like the PET scanner consume political attention and media oxygen, making it harder to advocate for the less glamorous work of maintenance and calibration.

To understand the human cost, consider the case of Grace Wanjiku, a 42-year-old mother of three from Kiambu County. She was diagnosed with stage IIB cervical cancer in July 2024 and referred to Kenyatta National Hospital for radiotherapy. Her first appointment was scheduled for November, four months later. By October, she had developed severe pelvic pain and was unable to work. When she finally started treatment, the machine broke down after two sessions. She was told to come back in three weeks. Grace's story is not unusual; it reflects the daily reality for thousands of women who face a system where even basic treatment is uncertain.

Why Foreign Gifts Skew Local Priorities

The phenomenon is not unique to Kenya. Across sub-Saharan Africa, foreign donors favour high-visibility, high-tech equipment that can be photographed and celebrated. A 2021 analysis in Globalization and Health examined 200 medical equipment donations to 10 African countries and found that fewer than half were still in use after two years. The most common reasons were lack of consumables, lack of trained operators, and lack of maintenance contracts.

Malawi offers a cautionary tale. In 2018, a Chinese company donated a CT scanner to Kamuzu Central Hospital in Lilongwe. It sat in its crate for nearly two years because the hospital's electrical system could not handle the power load and the manufacturer's warranty required a dedicated technician who was not on staff. When it was finally installed, it broke down within six months. The hospital later discovered that the donation agreement did not include a service plan. The machine remains non-functional as of early 2025.

Kenya's health ministry has tried to push back. In 2022, it issued guidelines requiring all equipment donations to be approved by a national committee that assesses need, feasibility, and sustainability. But the guidelines are not legally binding, and many hospitals accept donations directly. The result is a patchwork of machines that reflect donor enthusiasm rather than population need.

Dr. Grace Ochieng, a former director of medical services in Kenya's Ministry of Health, says the system needs a fundamental rethink. "Donors are not malicious. They genuinely want to help. But they work on annual cycles and need to show results to their boards. A PET scanner is a result. A well-calibrated linac is invisible. We need to make the invisible visible." She advocates for a regional approach to procurement and maintenance, perhaps through the East African Community, to pool resources and negotiate better service contracts.

The Cervical Cancer Case Study

Cervical cancer kills roughly 12 women every day in Kenya. It is the leading cause of cancer death among women, despite being largely preventable through HPV vaccination and screening. The World Health Organization's global strategy aims to eliminate cervical cancer by 2120, but Kenya is far off track. Vaccination coverage for girls aged 9–14 is around 40%, and screening coverage is below 20%. Most cases are diagnosed at a late stage, when curative treatment is no longer possible.

For women with locally advanced cervical cancer, radiotherapy combined with chemotherapy is the standard of care. It can cure about 60% of cases if delivered promptly and completely. But in Kenya, delays in starting radiotherapy reduce survival. A 2023 study at Kenyatta National Hospital found that the median time from diagnosis to start of radiotherapy was 18 weeks. By that point, many women had progressed to metastatic disease. The study's authors concluded that improving radiotherapy access would have a larger impact on cervical cancer survival than any new imaging technology.

The donated PET scanner is essentially irrelevant for cervical cancer prevention and early detection. Screening relies on visual inspection with acetic acid or HPV testing, both of which are cheap and can be done at the primary care level. Early-stage cervical cancer is treated with surgery or radiotherapy, not PET scans. Only in cases of suspected recurrence might a PET scan be useful, and even then, the benefit is modest for a population that cannot reliably access first-line treatment.

The mismatch between donation and disease burden is not lost on Kenyan oncologists. At a 2024 conference in Nairobi, several speakers called for a moratorium on accepting high-tech imaging donations until the radiotherapy crisis is resolved. But others argued that the two are not mutually exclusive—that Kenya needs both better diagnostics and better treatment. The disagreement is genuine. What is clear is that the current system, driven by donor preferences rather than evidence, is failing the women who need care most.

Policy Fixes That Cost Less Than a Scanner

Several low-cost policy changes could improve radiotherapy access without requiring new machines. The first is to standardise calibration contracts across all public hospitals. Currently, each facility negotiates its own service agreement, often with different vendors. A single national contract would reduce costs and ensure faster response times. The Kenyan Ministry of Health estimates that centralised procurement of spare parts could cut downtime by 30%.

A second fix is to require all equipment donations to include a five-year service plan, consumables, and training. This is already standard practice in some countries, such as Rwanda, where the Ministry of Health reviews all donations and rejects those that do not meet sustainability criteria. Kenya could adopt a similar policy, though it would require political will to enforce it against powerful donors.

A third approach is to redirect charity funds from hardware to human resources. Training additional radiation therapists, medical physicists, and biomedical engineers would have a multiplier effect. A single well-trained engineer can keep multiple machines running. The African Institute for Biomedical Engineering, based in Nairobi, runs a one-year certificate programme that has produced 40 graduates since 2020, but demand far outstrips supply. A modest investment of $200,000 per year could double the output.

Finally, regional cooperation could help. The East African Community has a pooled procurement mechanism for pharmaceuticals, but it does not yet cover medical equipment. Extending it to include linacs and spare parts would give member states bargaining power and reduce prices. A 2024 feasibility study commissioned by the African Union estimated that regional procurement could lower the cost of a new linac by 15–20% and reduce delivery times by months.

Beyond the Checklist: The Complexity of Donor Aid

Before the next donation arrives, Kenyan health officials and their international partners might benefit from a simple triage checklist. The first question: does this machine match the country's disease burden? For Kenya, the answer for a PET scanner is no—at least not until radiotherapy access is adequate. The second question: can the system staff and sustain it? If the answer requires importing engineers or buying isotopes from Europe, the machine may be a liability.

The third question is the hardest: will it reduce wait times for the poorest patients? A machine that serves only the wealthy may improve a hospital's prestige, but it does little for population health. Donors should score projects by equity impact, not novelty. A refurbished linac in a rural county might save more lives than a brand-new PET scanner in Nairobi, but it will not produce the same photo for the annual report.

Yet the checklist approach has its limitations. It assumes that donors and recipients operate on a level playing field, when in fact power imbalances often dictate terms. A hospital administrator who turns down a PET scanner risks alienating a funder who might also support other projects. And the allure of cutting-edge technology is hard to resist, even when it is not the most rational choice. Moreover, the line between "needed" and "unneeded" equipment is not always clear. As Kenya's economy grows and its disease burden shifts, advanced imaging may become more relevant. The question is not whether to ever accept such donations, but when and under what conditions.

The UK charity that donated the scanner meant well. But good intentions do not guarantee good outcomes. The challenge for Kenya—and for other countries facing similar dilemmas—is to channel donor enthusiasm toward the unglamorous but essential work of building a functional health system. That means investing in maintenance, training, and supply chains, even when those investments do not produce a ribbon-cutting ceremony. It also means having the courage to say no to gifts that, however well-intentioned, do more to burnish a donor's reputation than to improve population health.

Ultimately, the story of the PET scanner and the idle linacs is not a simple morality tale. It is a reminder that health systems are complex ecosystems, and that every intervention—whether a donation or a policy—ripples through them in ways that are hard to predict. The goal is not to eliminate donations, but to make them smarter, more accountable, and more aligned with the needs of the people they are meant to serve.